<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530211
Report Date: 09/09/2024
Date Signed: 09/09/2024 11:38:38 AM

Document Has Been Signed on 09/09/2024 11:38 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:BLESSED GARDEN HOME CORP.FACILITY NUMBER:
365530211
ADMINISTRATOR/
DIRECTOR:		RAMOS, LARIZA HOLCOMBFACILITY TYPE:
740
ADDRESS:935 BROOKSIDE AVENUETELEPHONE:
(909) 328-1828
CITY:REDLANDSSTATE: CAZIP CODE:
92373
CAPACITY: 6CENSUS: 0DATE:
09/09/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:39 AM
MET WITH:Lariza holcomb Ramos-AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Bernadette Allen and Renese Howell-Small conducted an announced visit to the facility for the purpose of a Pre-Licensing evaluation to operate a Residential Care Facility for the Elderly (RCFE) for a total capacity of 6 non-ambulatory residents. LPA's met with Lariza Holcomb Ramos-Administrator . LPA's Allen and Small observed the following:

Structure: Facility is a single-story home with four (4) bedrooms and two (2) bathrooms, one (1) bathroom is in the master bedroom, and one (1) bathroom is located in the main hallway. There is a living room, dining area, and kitchen.

Heating/Cooling System: Central heating and air conditioning systems.



Bedrooms: All bedrooms were adequately furnished with bed, chair, large closets, appropriate linens, adequate lighting, and an operational smoke alarm and fire extinguishers.

Bathrooms: Bathrooms have a working toilet, wash basin, and shower with handrails and non-slip mats. There was an adequate supply of towels, toilet paper, and toiletries. Water temperature measured at 105- 111 degrees F.

Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots and pans were observed. Cleaning supplies and knives/sharp instruments were secured in a locked cabinet and/or drawer. There was adequate room for food storage. Refrigerator/freezer were in working condition. There was adequate seating for meals. The washer/dryer and cleaning supplies were locked in the garage.

Living/Family room: Furnished with safe and adequate seating and furnishings. All items appear to be in good repair.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: BLESSED GARDEN HOME CORP.
FACILITY NUMBER: 365530211
VISIT DATE: 09/09/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Linens and Hygiene Supplies: An adequate supply of linens was available for the clients in care.

Yards/Outside: There was a covered area with adequate seating for staff and clients. There were no obstructions. There were no bodies of water observed anywhere on the property.

Garage: Garage was organized and free of obstructions.

Emergency Phone Numbers, and Exit Plan: Let-Us-KNOW poster and clients rights are posted.

General items: LPA's observed a working facility phone.

LPA's reviewed COMPONENT III with the applicant during this Pre Licensing Inspection.

This facility physical plant is prepared for licensure at this time.

A copy of this report was discussed and provided to Lariza Holcomb Ramos-Administrator at the conclusion of the visit.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2